肥胖科學、醫療化與性別身體政治

Science of Fat, Medicalisation and Gender Body Politics

主流的醫學社群與世界衛生組織都認為，肥胖（obesity）與過重（overweight）是很嚴重的世界流行病。相對於主流肥胖科學與肥胖流行病學論述，本文問到肥胖身體如何在特定肥胖科學與生物醫學知識中被建構為疾病。本文企圖整合社會學、女性主義、批判肥胖研究、STS研究四取向，並統稱這些取向為「批判的肥胖研究」，指出肥胖並非一病理學的問題，而是一個在醫療化的知識、社會文化與道德建構下出現的疾病。本文一方面耙梳台灣於90年代後肥胖的醫療化過程及其內在問題，另一方面，以性別研究的觀點檢視女性肥胖如何在醫學論述中被再現為「偏差化」與「病理學」身體，以及其性別政治意涵。台灣的肥胖議題隨著醫療化的進展而被加強於個別主體身上。用來支持肥胖流行的科學知識有許多不確定性，例如肥胖與疾病、死亡率、以及藥物治療的關係。肥胖科學中的重要測量工具BMI並非是一客觀標準，而是代表著人口治理技術、藥物廠商的利益、正常／偏差的身體劃界等意涵。性別化的肥胖身體在醫學論述再現中主要與荷爾蒙失序、生殖、養育問題有關，而男性肥胖僅被侷限於泌尿科的「單一性器官化」以及勃起功能有關；肥胖男性的病理學身體主要由性器官與荷爾蒙失調來界定，肥胖女性的病理學身體則是與生殖功能以及相連帶的母職實踐失敗來定義。肥胖身體與荷爾蒙、生殖功能的自然化的連結，使得女性肥胖特別成為醫療凝視的對象，同時建構了兩性肥胖身體為不健康與偏差的他者。

The mainstream medical community and the World Health Organization have defined obesity and overweight as an epidemic disease that presents a risk to health. The paper points out that the obesity and overweight is a social constructed disease rather than a pathological one. Contrary to the dominant discourse of science of fat and obesity epidemic, the article asks how the mainstream medical science constructs fat as an epidemical disease and fat people as the 'deviant' other. In recent years, scholars of the critical obesity research have given significant attentions to the issue of fat, they suggest that the obesity epidemic is much more than a natural phenomenon that described by science. Rather, the obesity science is a social idea, constructed within a complex of cultural 'tyranny of slenderness', gender ideal and scientific knowledge. This article suggests that obesity and overweight seen as an epidemic disease is scientific uncertain, which is influenced and constructed within the trend of (bio)medicalizaiton. BMI (Body Mass Index) as a tool of scientific measurement is not an objective index, rather, the establishment of BMI actually signifies a translative process between global and local medicalization of obesity science, which is correlated with global pharmaceutical interests. Furthermore, the BMI measurement can be said to construct the boundary of normal/deviant body with reference to idealized feminine body and masculine medical gaze within both popular culture and science. This article, one the one hand, analyzes the trend of (bio)medicalization of fat body after the 90s, on the other hand, examines gender representation and gender politics of fat people within medial discourse and popular culture. It is argued that fat woman's body is mainly related to hormone disorder, infertility, reproductive functions and the failure of motherhood; fat men's body has been related to sex organs and erectile dysfunction as the gender improper/deviant body. Thus, fat body is stigmatized within medical discourses through the naturalization of gender body and pathological body.